Formulir 3. KB Desa

LAPORAN FORMULIR 3.
( PELAYANAN KB )
Puskesmas : Form. 3a
Bulan : Januari 2018
KB Baru
Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Sasaran Sasaran
No Desa Sasaran PUS Sasaran Ibu
PUS 4 T PUS ALKI Bersalin
Bln Ini Kom Bln Ini Kom Bln Ini Kom Bln Ini Kom Bln Ini Kom Bln Ini Kom Bln Ini Kom Bln Ini
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Januari 2018

Kepala UPT Puskesmas …………. Pengelola KB
………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 #DIV/0!
2 0 #DIV/0!
3 0 #DIV/0!
4 0 #DIV/0!
5 0 #DIV/0!
6 0 #DIV/0!
7 0 #DIV/0!
8 0 #DIV/0!
9 0 #DIV/0!
10 0 #DIV/0!
11 0 #DIV/0!
12 0 #DIV/0!
13 0 #DIV/0!
14 0 #DIV/0!
15 0 #DIV/0!
16 0 #DIV/0!
17 0 #DIV/0!
18 0 #DIV/0!
19 0 #DIV/0!
20 0 #DIV/0!
21 0 #DIV/0!
22 0 #DIV/0!
23 0 #DIV/0!
24 0 #DIV/0!
25 0 #DIV/0!
26 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Januari 2018

Kepala UPT Puskesmas ………….
………………………………
Puskesmas :
Kegagalan Drop Out
Kondom Pil Suntik AKDR Implan MOW MOP Jumlah Kondom Pil Suntik AKDR Implan MOW
No Desa
%
Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Ini Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom
Kom
Ini Ini Ini Ini Ini Ini Ini Ini Ini Ini Ini Ini Ini
1 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 ###
2 0 0 0 ###
3 0 0 0 ###
4 0 0 0 ###
5 0 0 0 ###
6 0 0 0 ###
7 0 0 0 ###
8 0 0 0 ###
9 0 0 0 ###
10 0 0 0 ###
11 0 0 0 ###
12 0 0 0 ###
13 0 0 0 ###
14 0 0 0 ###
15 0 0 0 ###
16 0 0 0 ###
17 0 0 0 ###
18 0 0 0 ###
19 0 0 0 ###
20 0 0 0 ###
21 0 0 0 ###
22 0 0 0 ###
23 0 0 0 ###
24 0 0 0 ###
25 0 0 0 ###
26 0 0 0 ###
Puskesmas 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
Kdm Pil Suntik AKDR Implan
Kdm Pil Suntik AKDR Implan MOW MOP Kdm Pil Suntik AKDR Implan MOW MOP
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 - #DIV/0!
2 - #DIV/0!
3 - #DIV/0!
4 - #DIV/0!
5 - #DIV/0!
6 - #DIV/0!
7 - #DIV/0!
8 - #DIV/0!
9 - #DIV/0!
10 - #DIV/0!
11 - #DIV/0!
12 - #DIV/0!
13 - #DIV/0!
14 - #DIV/0!
15 - #DIV/0!
16 - #DIV/0!
17 - #DIV/0!
18 - #DIV/0!
19 - #DIV/0!
20 - #DIV/0!
21 - #DIV/0!
22 - #DIV/0!
23 - #DIV/0!
24 - #DIV/0!
25 - #DIV/0!
26 - #DIV/0!
Puskesmas - - - #REF!

Puskesmas :
PUS TIDAK KB (Komulatif bulan ini) KB PASCA SALIN
PUS 4T Ber KB PUS ALKI Ber
Tidak KOMPLIKASI EFEK SAMPING
(Komulatif) KB (Komulatif) Kondom Pil Suntik AKDR Implan MOW
Ingin
No Desa Ingin Anak
Hamil Anak (TIA) / Jumlah %
(IA) Unmeet
Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln
Need Kom % Kom % % %
Ini Ini Ini Ini Ini Ini Ini Ini
1 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Kom Bln Bln

Ini Kom Ini Kom
1 0 0 0 - ###
2 0 0 0 - ###
3 0 0 0 - ###
4 0 0 0 - ###
5 0 0 0 - ###
6 0 0 0 - ###
7 0 0 0 - ###
8 0 0 0 - ###
9 0 0 0 - ###
10 0 0 0 - ###
11 0 0 0 - ###
12 0 0 0 - ###
13 0 0 0 - ###
14 0 0 0 - ###
15 0 0 0 - ###
16 0 0 0 - ###
17 0 0 0 - ###
18 0 0 0 - ###
19 0 0 0 - ###
20 0 0 0 - ###
21 0 0 0 - ###
22 0 0 0 - ###
23 0 0 0 - ###
24 0 0 0 - ###
25 0 0 0 - ###
26 0 0 0 - ###
Puskesmas 0 0 0 0 - ###

LAPORAN FORMULIR 3. ( PELAYANAN KB )
Bulan : Februari 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 28 februari 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 28 februari 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!
Puskesmas - - - #DIV/0!

Puskesmas :
(Komulatif) KB (Komulatif) Kondom Pil Suntik AKDR Implan
Ingin
No Desa Ingin Anak
(IA) Unmeet
Bln Bln Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom
Need Kom % Kom % Kom % Kom %
Ini Ini Ini Ini Ini Ini Ini
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Bln Kom Bln Kom Bln Kom
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Maret 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Maret 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Maret 2018

………………………………
Puskesmas :
Bulan : Maret 2018
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Bulan : Maret 2018
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Bulan : Maret 2018
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : April 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 30 April 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 30 April 2018

………………………………
Puskesmas :
Bulan : April 2018
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Bulan : April 2018
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Bulan : April 2018
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Mei 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Mei 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Mei 2018

………………………………
Puskesmas :
Bulan : Mei 2018
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Bulan : Mei 2018
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Bulan : Mei 2018
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Juni 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 30 Juni 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 30 Juni 2018

………………………………
Puskesmas :
Bulan : Juni 2018
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Bulan : Juni 2018
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Bulan : Juni 2018
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Juli 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Juli 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Juli 2018

………………………………
Puskesmas :
Bulan : Juli 2018
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Bulan : Juli 2018
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Bulan : Juli 2018
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Agustus 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Agustus 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Agustus 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : September 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 30 September 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 30 September 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Oktober 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Oktober 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Oktober 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : November 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 30 November 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 30 November 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Bulan : Desember 2018
KB Baru

Sasaran Sasaran
1 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0
Puskesmas - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Purworejo, 31 Desember 2018

………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Bulan
Jumlah
No Desa
%
Kom
1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0 0 #DIV/0!
20 0 0 #DIV/0!
21 0 0 #DIV/0!
22 0 0 #DIV/0!
23 0 0 #DIV/0!
24 0 0 #DIV/0!
25 0 0 #DIV/0!
26 0 0 #DIV/0!
Puskesmas 0 #DIV/0!
Purworejo, 31 Desember 2018

………………………………
Puskesmas :
Kegagalan Drop Out
No Desa
%
Kom
1 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3b
Bulan
Drop Out
MOP Jumlah
No Desa
%
Bln Kom Bln Ini Kom
Ini
1 0 0 0 0 ###
2 0 0 0 0 ###
3 0 0 0 0 ###
4 0 0 0 0 ###
5 0 0 0 0 ###
6 0 0 0 0 ###
7 0 0 0 0 ###
8 0 0 0 0 ###
9 0 0 0 0 ###
10 0 0 0 0 ###
11 0 0 0 0 ###
12 0 0 0 0 ###
13 0 0 0 0 ###
14 0 0 0 0 ###
15 0 0 0 0 ###
16 0 0 0 0 ###
17 0 0 0 0 ###
18 0 0 0 0 ###
19 0 0 0 0 ###
20 0 0 0 0 ###
21 0 0 0 0 ###
22 0 0 0 0 ###
23 0 0 0 0 ###
24 0 0 0 0 ###
25 0 0 0 0 ###
26 0 0 0 0 ###

Puskesmas :
Ganti Cara KB Aktif
Keluar Masuk
No Desa
1 0 - - - - -
2 0 - - - - -
3 0 - - - - -
4 0 - - - - -
5 0 - - - - -
6 0 - - - - -
7 0 - - - - -
8 0 - - - - -
9 0 - - - - -
10 0 - - - - -
11 0 - - - - -
12 0 - - - - -
13 0 - - - - -
14 0 - - - - -
15 0 - - - - -
16 0 - - - - -
17 0 - - - - -
18 0 - - - - -
19 0 - - - - -
20 0 - - - - -
21 0 - - - - -
22 0 - - - - -
23 0 - - - - -
24 0 - - - - -
25 0 - - - - -
26 0 - - - - -
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - -

Puskesmas Form. 3c
Bulan
KB Aktif
No Desa
MOW MOP Jml %
1 0 - - - #DIV/0!
2 0 - - - #DIV/0!
3 0 - - - #DIV/0!
4 0 - - - #DIV/0!
5 0 - - - #DIV/0!
6 0 - - - #DIV/0!
7 0 - - - #DIV/0!
8 0 - - - #DIV/0!
9 0 - - - #DIV/0!
10 0 - - - #DIV/0!
11 0 - - - #DIV/0!
12 0 - - - #DIV/0!
13 0 - - - #DIV/0!
14 0 - - - #DIV/0!
15 0 - - - #DIV/0!
16 0 - - - #DIV/0!
17 0 - - - #DIV/0!
18 0 - - - #DIV/0!
19 0 - - - #DIV/0!
20 0 - - - #DIV/0!
21 0 - - - #DIV/0!
22 0 - - - #DIV/0!
23 0 - - - #DIV/0!
24 0 - - - #DIV/0!
25 0 - - - #DIV/0!
26 0 - - - #DIV/0!

Puskesmas :
Ingin
No Desa Ingin Anak
(IA) Unmeet
1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

2 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
3 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
4 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
5 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
6 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
7 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
8 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
9 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
10 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
11 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
12 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
13 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
14 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
15 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
16 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
17 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
18 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
19 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
20 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
21 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
22 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
23 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
24 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
25 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
26 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0
Puskesmas - - - - ### - ### - ### 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0

Puskesmas Form. 3d
Bulan
KB PASCA SALIN
MOW MOP Jumlah

No Desa
%
Ini Ini Ini
1 0 0 0 0 - ###
2 0 0 0 0 - ###
3 0 0 0 0 - ###
4 0 0 0 0 - ###
5 0 0 0 0 - ###
6 0 0 0 0 - ###
7 0 0 0 0 - ###
8 0 0 0 0 - ###
9 0 0 0 0 - ###
10 0 0 0 0 - ###
11 0 0 0 0 - ###
12 0 0 0 0 - ###
13 0 0 0 0 - ###
14 0 0 0 0 - ###
15 0 0 0 0 - ###
16 0 0 0 0 - ###
17 0 0 0 0 - ###
18 0 0 0 0 - ###
19 0 0 0 0 - ###
20 0 0 0 0 - ###
21 0 0 0 0 - ###
22 0 0 0 0 - ###
23 0 0 0 0 - ###
24 0 0 0 0 - ###
25 0 0 0 0 - ###
26 0 0 0 0 - ###
Puskesmas 0 0 0 0 0 - ###

Tahun : 2018
KB Baru

Sasaran Sasaran
No Bulan Sasaran PUS Sasaran Ibu
1 Januari - - - - - - - - - - - - - - - - - - -
2 Februari - - - - - - - - - - - - - - - - - - -
3 Maret - - - - - - - - - - - - - - - - - - -
4 April - - - - - - - - - - - - - - - - - - -
5 Mei - - - - - - - - - - - - - - - - - - -
6 Juni - - - - - - - - - - - - - - - - - - -
7 Juli - - - - - - - - - - - - - - - - - - -
8 Agustus - - - - - - - - - - - - - - - - - - -
9 September - - - - - - - - - - - - - - - - - - -
10 Oktober - - - - - - - - - - - - - - - - - - -
11 November - - - - - - - - - - - - - - - - - - -
12 Desember - - - - - - - - - - - - - - - - - - -
- - - - - - - -
Mengetahui
………………………………… ………………………………
NIP. NIP.
Puskesmas Form. 3a
Tahun
Jumlah
No Bulan
%
Kom
1 Januari - #DIV/0!
2 Februari - #DIV/0!
3 Maret - #DIV/0!
4 April - #DIV/0!
5 Mei - #DIV/0!
6 Juni - #DIV/0!
7 Juli - #DIV/0!
8 Agustus - #DIV/0!
9 September - #DIV/0!
10 Oktober - #DIV/0!
11 November - #DIV/0!
12 Desember - #DIV/0!
………………………………
Puskesmas :
Tahun : 2018
Kegagalan Drop Out
No Bulan
%
Kom
1 Januari - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
2 Februari - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
3 Maret - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
4 April - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
5 Mei - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
6 Juni - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
7 Juli - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
8 Agustus - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
9 September - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
10 Oktober - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
11 November - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
12 Desember - - - - - - - - - - - - - - - - ### - - - - - - - - - - - -
- - - - - - - - - - - - - -
Puskesmas Form. 3b
Tahun
Drop Out
MOP Jumlah
No Bulan
%
Bln Kom Bln Ini Kom
Ini
1 Januari - - - - ###
2 Februari - - - - ###
3 Maret - - - - ###
4 April - - - - ###
5 Mei - - - - ###
6 Juni - - - - ###
7 Juli - - - - ###
8 Agustus - - - - ###
9 September - - - - ###
10 Oktober - - - - ###
11 November - - - - ###
12 Desember - - - - ###
- -
Puskesmas :
Tahun : 2018
Ganti Cara KB Aktif
Keluar Masuk
No Bulan
1 Januari - - - - - - - - - - - - - - - - - - -
2 Februari - - - - - - - - - - - - - - - - - - -
3 Maret - - - - - - - - - - - - - - - - - - -
4 April - - - - - - - - - - - - - - - - - - -
5 Mei - - - - - - - - - - - - - - - - - - -
6 Juni - - - - - - - - - - - - - - - - - - -
7 Juli - - - - - - - - - - - - - - - - - - -
8 Agustus - - - - - - - - - - - - - - - - - - -
9 September - - - - - - - - - - - - - - - - - - -
10 Oktober - - - - - - - - - - - - - - - - - - -
11 November - - - - - - - - - - - - - - - - - - -
12 Desember - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
Puskesmas Form. 3c
Tahun
KB Aktif
No Bulan
MOW MOP Jml %
1 Januari - - - #REF!
2 Februari - - - #DIV/0!
3 Maret - - - #DIV/0!
4 April - - - #DIV/0!
5 Mei - - - #DIV/0!
6 Juni - - - #DIV/0!
7 Juli - - - #DIV/0!
8 Agustus - - - #DIV/0!
9 September - - - #DIV/0!
10 Oktober - - - #DIV/0!
11 November - - - #DIV/0!
12 Desember - - - #DIV/0!
Puskesmas :
Tahun : 2018
Ingin
No Bulan Ingin Anak
(IA) Unmeet
1 Januari - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
2 Februari - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
3 Maret - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
4 April - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
5 Mei - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
6 Juni - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
7 Juli - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
8 Agustus - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
9 September - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
10 Oktober - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
11 November - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
12 Desember - - - - ### - ### - ### - - ### - - ### - - - - - - - - - -
- - - - - - -
Puskesmas Form. 3d
Tahun
KB PASCA SALIN
MOW MOP Jumlah

No Bulan
%
Ini Ini Ini
1 Januari - - - - - - ###
2 Februari - - - - - - ###
3 Maret - - - - - - ###
4 April - - - - - - ###
5 Mei - - - - - - ###
6 Juni - - - - - - ###
7 Juli - - - - - - ###
8 Agustus - - - - - - ###
9 September - - - - - - ###
10 Oktober - - - - - - ###
11 November - - - - - - ###
12 Desember - - - - - - ###
- - -
Desa : Form. 3a
Tahun : 2018
KB Baru

Sasaran Sasaran
No Bulan Sasaran PUS Sasaran Ibu
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Bidan Desa
NIP/NRPTT.
Desa Form. 3a
Tahun
Jumlah
No Bulan
%
Kom
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
RPTT.
Desa :
Tahun : 2018
Kegagalan Drop Out
No Bulan
%
Kom
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Desa Form. 3b
Tahun
Drop Out
MOP Jumlah
No Bulan
%
Bln Kom Bln Ini Kom
Ini
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Desa :
Tahun : 2018
Ganti Cara KB Aktif
Keluar Masuk
No Bulan
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Desa Form. 3c
Tahun
KB Aktif
No Bulan
MOW MOP Jml %
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Desa :
Tahun : 2018
Tidak PUS 4T Ber KB PUS 4ALKI Ber KOMPLIKASI EFEK SAMPING
Ingin (Komulatif) KB (Komulatif) Kondom Pil Suntik AKDR Implan MOW
No Bulan Ingin Anak
(IA) Unme
et Bln Bln Bln Kom Bln Kom Bln Kom Bln Kom Bln Kom Bln
Kom % Kom % Kom % Kom %
Need Ini Ini Ini Ini Ini Ini Ini Ini
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
Desa Form. 3d
Tahun
KB PASCA SALIN
MOW MOP Jumlah

No Bulan
%
Kom Bln Bln

Ini Kom Ini Kom
1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember

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Formulir 3. KB Desa

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LAPORAN FORMULIR 3.

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 31 Januari 2018

Purworejo, 31 Januari 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah

Kom Bln Bln

Kepala UPT Puskesmas ………….

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 28 februari 2018

Purworejo, 28 februari 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah

Kepala UPT Puskesmas ………….

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 31 Maret 2018

Purworejo, 31 Maret 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah

Kepala UPT Puskesmas ………….

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 30 April 2018

Purworejo, 30 April 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah

Kepala UPT Puskesmas ………….

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 31 Mei 2018

Purworejo, 31 Mei 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah

Kepala UPT Puskesmas ………….

Kondom Pil Suntik AKDR Implan MOW MOP Jumlah

Mengetahui Purworejo, 30 Juni 2018

Purworejo, 30 Juni 2018

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

Kepala UPT Puskesmas ………….

1 0 - ### ### ### 0 ### 0 ### 0 0 0 0 0

Kepala UPT Puskesmas ………….

MOW MOP Jumlah